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New Most Cost-Effective Setting Program webpage

October 3, 2018

On October 1, 2018, Independence launched a new webpage to support its Most Cost-Effective Setting Program for members enrolled in commercial products. As part of this program, Independence reviews the requested site of service where members receive certain specialty drugs eligible for coverage under the medical benefit. This review ensures that drugs are being administered in settings that are both safe and cost-effective.

In addition to providing detailed information about the Most Cost-Effective Setting Program, this webpage includes a comprehensive list of specialty drugs that require review for site of service. This list is updated throughout the year, as the program is expanded.

For more information about the Most Cost-Effective Setting Program, visit our new, dedicated webpage.

Recent additions to the Most Cost-Effective Setting Program

The following drugs require precertification approval for medical necessity and setting as of the date noted:*

  • Adagen? (pegademase bovine) – AS OF OCTOBER 1, 2018
  • Crysvita? (burosumab-twza) – AS OF OCTOBER 1, 2018
  • FulphilaTM (pegfilgrastim-jmdb) – AS OF JUNE 25, 2018
  • Ilaris? (canakinumab) – NEW FOR JANUARY 1, 2019
  • Naglazyme? (galsulfase) – AS OF OCTOBER 1, 2018
  • OnpattroTM (patisiran) – AS OF AUGUST 10, 2018

*This list of drugs is subject to change.

Note: All biosimilars to the originator products in this program are subject to precertification review for most cost-effective setting.

This content was prepared for the Provider News Center and may not be reproduced in any way without the express written permission of Independence Blue Cross. Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association.
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